EVIDENCE OF PROPERTY INSURANCE
,
orj-\-o dM I C>>f14l R,\;L .
DATE lMMIDDlYY1
10/12/01
THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE
RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PRODUCER P,tt~N~O EXl: 727-796-6666
Acardia Southeast, Inc.
PO Box 31666
Tampa, FL 33631-3666
COMPANY
FIREMAN'S FUND INSURANCE CO
POBOX 116055
ATLANTA, GA 30368-6055
CODE: 09-1031 50
~3~~g~ER ID #: PER54440
INSURED
SUB CODE:
PACT, Inc., Performing Arts
Center Foundation, Inc.
1111 McMullen Booth Road
Clearwater FL 33759-
EFFECTIVE DATE
10/01/01
EXPIRATION DATE
10/01/02
CONTINUED UNTIL
TERMINATED IF CHECKED
LOAN NUMBER
POLICY NUMBER
MZX80789750 01
THIS REPLACES PRIOR EVIDENCE DATED:
10/12/01
1111 MCMULLEN BOOTH RD (RUTH ECKERD HALLl
CLEARWATER FL 34619
CQVERAGE1iiNFORMATIOI\l'"
COV ERAG E/PERILS/FORMS
AMOUNT OF INSURANCE
DEDUCTIBLE
BUILDING
BUILDING WIND & HAIL DEDUCTIBLE
CONTENTS
CONTENTS WIND & HAIL DEDUCTIBLE
BUSINESS INCOME
SPECIAL FORM
REPLACEMENT COST
AGREED AMOUNT
17745500
1880000
5000
1%
5000
1%
- RECE\VED
:'/"\ 1 6 "('m
LcJ,
~~J ".J I
1
- PARKS & RECREAT\ON
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.....
1774000
,~~ooDI1~~O~<!!~ijll~i?J~.Si!Jj.29ijditi()Il$1
CITY IS INCLUDED AS ADDL INSURED FOR FUNDING CONSTRUCTION AND
WILL BECOME OWNER AS BONDS ARE RETIRED.
RECEIVED
OCT 1 5 1nn1
RISK MANAGEMENT
CITY OF CLEARWATER
ATTN: LEO SCHRADER, RISK MGMT
POBOX 4748
CLEARWATER FL 33758-4748
AUTHORIZED REPRESENTATIVE
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ACORD CERTIFICA TE OF LIABILITY INSURANCE I DATE IMMIDDIYY)
TII 10/12/01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ACaRDIA EAST - TAMPA BAY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.o. Box 31666 HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33631-3666
727-796-6666 INSURERS AFFORDING COVERAGE
INSURED PACT, Inc., Performing Arts INSURER A: GULF INSURANCE COMPANY
Center Foundation, Inc. INSURER B: FIREMAN'S FUND INSURANCE CO
1111 McMullen Booth Road INSURER C: Zenith Insurance Co-DB
Clearwater FL 33759 INSURER D:
I INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER blJ.~gJ~~~%"R,~~ P8k!fEY,~rXJ~~JJ~~ LIMITS
LTR
A GENERAL LIABILITY CGL061 0743 10/01/01 10/01/02 EACH OCCURRENCE $ 1000000
f--
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone firel $ 50000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5000
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - CDMP/OP AGG $ 2000000
Xl n PRO- nLOC
X POLICY JECT
A AUTOMOBILE LIABILITY BA0485697 10/01/01 10/01/02 COMBINED SINGLE LIMIT
- lEa accident) $ 1000000
ANY AUTO
-
--'- ALL OWNED AUTOS BODILY INJURY
$
~ SCHEDULED AUTOS (Per personl
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
==rAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESS LIABILITY XYZ96684899 10/01/01 10/01/02 EACH OCCURRENCE $ 10000000
~ OCCUR o CLAIMS MADE AGGREGATE $ 10000000
$
R DEDUCTIBLE $
RETENTION $ $
C WORKERS COMPENSATION AND 60942 1/01/01 1/01/02 X 1 ~~7Iru;~.:1 IOTH-
ER
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 1000000
E,L, DISEASE - EA EMPLOYEE $ 1000000
E,L, DISEASE - POLICY LIMIT $ 1000000
OTHER
,- ~ 'f'r1\1Cn ----.. .-....
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT PECIAL PROVI jVLI' LV n[;;;.VL-1 y a-IJ
CITY IS INCLUDED AS ADDL INSURED FOR FUNDING cm OTRU1
WILL BECOME OWNER AS BONDS ARE RETIRED. OfT 1 5 ?001
,., /-,..,... 1 6 2001
\ \."
R SK MANAGEMENT
CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER: TJOIIHH :H~ A IlllN
CITY OF CLEARWATER U, '"t: AIIUVt: ut:"""'IIt:D POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ---1Q.. DAYS WRITTEN
ATTN: LEO SCHRADER, RISK MGMT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
POBOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
CLEARWATER FL 33758-4748 REPRESEN;rATlVES, .
AUTH c.,..... A~ r-t? ....
I -- "'of -/ r"
ACORD 25-S 17/971
ce'. 0~ ~ I ((~JvJ
~-73
e ACORD CORPORATION 1988
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I
I
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-5 (7/97)